71 The study of different presentations of breast lumps in radiographic imaging. Shalini Saraswat. 1 ,Amit Kumar. 21 Assistant Professor, Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre, Moradabad- 24400, U.P.,India 2 Assistant Professor, Department of ENT, Teerthanker Mahaveer Medical College & Research Centre, Moradabad- 24400, U.P.,India Corresponding Author: Dr Shalini Saraswat,,Assistant Professor, Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre, Moradabad, U.P.,IndiaEMAIL: [email protected]Abstract:Introduction: Breast USG is an established and accurate tool for the primary evaluation of breast lumps and pathology. It also compliments X- ray mammography in further evaluation and characterization of breast masses and thus avoids surgeries in benign breast diseases and pathology. Method: For USG examination of the breast lumps, a linear-array transducer of 5-7 MHz frequency is required with a good resolution machine. Results: We present a pictorial essay on the role of USG in evaluation and characterization of various breast lumps and pathology. Conclusion: Breast sonography considerably improves the visualization and evaluation of lumps in mammographically radiodense breasts and helpful in the characterization of it, either as solid or cystic lesion. It also improves the specificity of X-ray mammography when used as an adjunct to it. It is also helpful in guiding FNAC/ biopsy from the breast masses. Keywords: Breast, ultrasound:, sono-mammography, X- ray mammography INTRODUCTION: Because of increased incidence of breast cancer in females, a breast lump may worry both the patient and clinician. Breast ultrasonography is appropriate investigation for the initial evaluation of a female younger than 30 years with a palpable breast lump and also helpful in the evaluation of X- ray mammographic abnormalities i.e. masses, focal asymmetric densities, areas of architectural distortion and palpable abnormalities not seen mammographically. 1 Additional imaging with MRI and FNAC/ biopsy might be needed in the cases, for the confirmation of the sonographic diagnosis. USG guided core-needle biopsy (CNB) is a frequently performed and accurate alternative to stereotactic/ excisional biopsy. 2, 3 USG may be guided aspiration of symptomatic cysts, complicated cysts, and possible abscesses are also readily performed. 4 USG feature analysis of breast masses continues to improve 5 , though interobserver variability continues to be a problem, in avoiding biopsy. 6, 7 An illustrated Breast Imaging Reporting and Data System (BI-RADS) ultrasonographic lexicon 8 helpful in improving observer performance.
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71
The study of different presentations of breast lumps in radiographic
imaging.
Shalini Saraswat.1 ,Amit Kumar.21Assistant Professor, Department of Radiodiagnosis, Teerthanker
Mahaveer Medical College & Research Centre, Moradabad- 24400, U.P.,India
2Assistant Professor, Department of ENT, Teerthanker Mahaveer Medical College & Research Centre,
Moradabad- 24400, U.P.,India
Corresponding Author:
Dr Shalini Saraswat,,Assistant Professor, Department of Radiodiagnosis, Teerthanker Mahaveer
Medical College & Research Centre, Moradabad, U.P.,IndiaEMAIL: [email protected]
Abstract:Introduction: Breast USG is an established and accurate tool for the primary evaluation of breast
lumps and pathology. It also compliments X- ray mammography in further evaluation and characterization of
breast masses and thus avoids surgeries in benign breast diseases and pathology. Method: For USG
examination of the breast lumps, a linear-array transducer of 5-7 MHz frequency is required with a good
resolution machine. Results: We present a pictorial essay on the role of USG in evaluation and characterization
of various breast lumps and pathology. Conclusion: Breast sonography considerably improves the visualization
and evaluation of lumps in mammographically radiodense breasts and helpful in the characterization of it,
either as solid or cystic lesion. It also improves the specificity of X-ray mammography when used as an adjunct
to it. It is also helpful in guiding FNAC/ biopsy from the breast masses.
Keywords: Breast, ultrasound:, sono-mammography, X- ray mammography
INTRODUCTION: Because of increased incidence of breast cancer in females, a breast lump may
worry both the patient and clinician. Breast ultrasonography is appropriate investigation for the
initial evaluation of a female younger than 30 years with a palpable breast lump and also helpful in
the evaluation of X- ray mammographic abnormalities i.e. masses, focal asymmetric densities, areas of
architectural distortion and palpable abnormalities not seen mammographically.1 Additional imaging
with MRI and FNAC/ biopsy might be needed in the cases, for the confirmation of the sonographic
diagnosis.
USG guided core-needle biopsy (CNB) is a frequently performed and accurate alternative to
stereotactic/ excisional biopsy. 2, 3 USG may be guided aspiration of symptomatic cysts, complicated
cysts, and possible abscesses are also readily performed. 4
USG feature analysis of breast masses continues to improve 5, though interobserver variability
continues to be a problem, in avoiding biopsy.6, 7 An illustrated Breast Imaging Reporting and Data
System (BI-RADS) ultrasonographic lexicon8 helpful in improving observer performance.
72
METHOD: For USG examination of the breast lumps, a linear-array transducer of 5-7 MHz frequency
is required with a good resolution machine. The patient is scanned in the supine position for the inner
part of thebreast and then in the contralateral posterior oblique position with the ipsilateral raised
arm, for the axilla and upper outer quadrants.
RESULT & DISCUSSION:
Normal Anatomy [Figure 1]
On sonography, normal breast parenchyma has alternate hyperechoic and hypo echoic layers:
Skin – hyperechoic
Subcutaneous fat – hypoechoic
Fibroglandular breast parenchyma – hyper echoic
Retromammary fat – hypo echoic
Muscle (Pectoralis major) – hyperechoic
Cooper's ligaments are echogenic bands that suspend the breast from the superficial layer of the
fascia.
Figure 1 : Normal breast anatomy on USG.
a) hyperechoic- skin, b) hypoechoic- subcutaneous fat, c) hyperechoic- fibroglandular breast